WQ0009098_Monitoring - 12-2021_20220701

*FORM: NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page ( of
Permit No. ' '+I� ��i Facility Name:c. • � � �rounty: I� + c Month pprem erer I (
PPI: Flow Measuring Point: Ell ❑ Effluent ❑ N w generated Parameter Monitoring Point: ❑ tnfuent [1 Effluent El Groundwater Lowering ❑ Surf
Parameter Code —a. 50050
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0 U ~ U � u.
0
O ft
24-hr hrs GPD
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5 kk r
6
7
D,Sta,(T P1 :1:; L•- o
10
11
12
13 LLf , wi
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21
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25 lng^i.,), . 1L;)
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26 ^ �,
27 ` ;;, : t- ,7Urn.
28
29
30
31
,
Average:
Daily Maximum:
Daily Minimum:
Sampling Type:
Monthly Avg.Limit:
Daily Limit:
Sample Frequency:

FORM: NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page of •
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Compliant ❑ Non-Cc
If the facility is non-compliant,please explain in the space below the reason(s)the facility was not in compliance. Provide in your explanation the date(s)of the non-compliance and describe the col
action(s)taken.Attach additional sheets if necessary.
/1\10 1.1)(tatE149
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k) *TA 5
Operator in Responsible Charge(ORC)Certification Permittee Certification
ORC t,px ` ke,Y V l,i 1 QI 1 Permittee: GZ.I+�p Q,1n/� 1�/ Lt V1^i"'� -Erte �Jvi(�
Certification No.: 11 L a©3 Signing Official: j �o Taw'. ctkj I l Q✓�
Grade: 5T Phone Number: C ^beui,_ ei Signing Official's Tit :
Has the ORC changed since the previous NDMR? r] Yes No Phone Number: Permit Expiration:
q Ct D--- 9401ka 31
QaticodthoicA4a4 I Ola 6.1eitikail\ titOloa
Signature ate Signature Da
By this signature,I certify that this report is accurrate and complete to the best of my knowledge. I certify,under alty of law,that this document and all attachments were prepared under my direction or supervision
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitt
my inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the in
information submitted is,to the best of my knowledge and belief,true,accurate,and complete.I am aware that there
penalties for submitting false information,including the possibility of fines and imprisonment for knowing violat
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

-FORM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page Ol of c t.
Permit No.:4000CtOtegl Facility Name: ' C rFp5►(- ime�irfCounty: Month er <� (
Field Name: field Name: Field Name: Field Name:
Did irrigation occur
Area(acres): Area(acres): Area(acres): Area(acres):
at this faci ' y?
Cover Crop: Cover Crop: Cover Crop: Cover Crop:
❑ YES NO Hourly Rate(in): Hourly Rate(in): Hourly Rate(in): Hourly Rate(in):
Annual Rate(in): Annual Rate(in): Annual Rate(in): Annual Rate(in):
Weather Freeboard Field Irrigated? YES ❑ NO Field Irrigated? ❑ YES ❑ NO Field Irrigated? ❑ YES ❑ NO Field Irrigated? ❑ YES
w
v 3 o w m °) a» '0 rn E a) m y -a rn E a) o -o a c E rn m y -o o)
T O Es 2 a) 5 -2 E 2 a) :: T C 7 C E d a) 18 T C 7 ` C E N a) a) >. C 7 L C E a) a) m >
m V L .- , ° u a Ea 'v E a 'o a E 'a o E 3 v m a E m E 5 a o o Ern m
o m o ° o •- o a I= •c p Si "x O o o a i= •°) D o )4, 2 o o a i= o o xo 0 o a F= •` o o
r E a�i m m a > ¢ _ -J 2 _ .J > ¢ g > ¢ > ¢
0 F a al
16
°F in ft ft gal min in in gal min in in gal min in in gal min in
1
2 ti
3 p Oa' pooJe(
4
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7 7filet 0 ir\ ii+-7
8 ,
9 / _ ` r
11 1.--- ALA , I1:
-
12
13
14
15
16
17
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19 _
20
21
22
23
24
25
26
27
28
29
30
31
Monthly Loading: .,
12 Month Floating Total(in): a x

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
Page
of
Compliant
❑ Non-Compli
Compliant
❑ Non-Compli
Compliant
❑ Non-Compli
12 Compliant ❑ Non-Compli
0/compliant ❑ Non-Compli
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the cor
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
ORC 1 \Q 1 `✓ 1 tj v �.C, M (, ([a
Certification No.: 1 i(103 I
Grade: �j� Phone Number: "l � q—k?Q(n-a5l? q
Has the ORC changed since the previous NDAR-1? ❑ Yes VNO
Signature &`Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: ` r
Signing Official: jt/j /r Y'� t �,lao
Signing Official's Title^ a
& LrQ��
Phone Number: (�(�[ Permit Exp.:
a ja_3�5a-aaa��3
Signature pa
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. E
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the inform
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violation
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617